Advanced Medical Life Support (AMLS)

Which working diagnosis is appropriate for a patient with fever, nausea, vomiting, RLQ pain, and a positive Psoas Sign?

1. GI bleed

2. Acute pancreatitis

3. Pleural effusion

4. Appendicitis

The correct answer is: Appendicitis

The presence of fever, nausea, vomiting, right lower quadrant (RLQ) pain, and a positive Psoas Sign strongly indicates appendicitis as the appropriate working diagnosis. Appendicitis often presents with these classic symptoms, where RLQ pain is particularly significant due to the anatomical location of the appendix. The Psoas Sign, which is elicited by stretching the iliopsoas muscle through movements such as hip flexion or extension against resistance, can indicate that the inflamed appendix is irritating the surrounding musculature or peritoneum. In contrast, a gastrointestinal bleed would more commonly present with symptoms like melena or hematemesis and would not typically include the specific RLQ pain associated with appendicitis. Acute pancreatitis often presents with epigastric pain that can radiate to the back, along with nausea and vomiting, but again lacks the localized RLQ pain and signs suggestive of appendiceal inflammation. Pleural effusion may lead to fever and respiratory symptoms, but it does not correlate with RLQ pain or positive Psoas Sign. Overall, the combination of the patient's symptoms and positive Psoas Sign aligns with the diagnosis of appendicitis, highlighting its importance in rapid assessment and management in an acute